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CC Nov 2015 Acromioclavicular (AC) Joint Dislocation

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echoecho's version from 2015-11-27 20:55

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Question Answer
What is another term for acromioclavicular (AC) joint dislocation?shoulder seperation
This condition isi usually the result of what? Give an example?1) direct trauma to the acromion process 2) often as a result of a fall or while competing in contact sports
Can a fall onto an outstretched hand (FOOSH) also cause AC joint dislocation?yes
Why is this condition more common in men than in women?due to higher rates of participation in high-risk activities (hockey and snowboarding)
What are the findings of this condition on physical examination?localized tenderness at the AC joint, often accompanied by swelling
Displacement of the clavicle can resujlt in what abnormality?a palpable abnormality
In severe cases, what may be present?skin tenting
Pain is typically exacerbated with what movement?cross-body arm adduction
Radiographic evaluation includes what 2 views?1) AP (anteroposterior) vieww 2) Zanca views
Define the Zanca view?it is a modified AP view with 10 degree cephalad angulation so that the clavicle is not projected over the body of the scapula
What two things classify the type of dislocation and determines treatment?1) degree of clavicular displacement 2) the direction of clavicular displacement
Although described in older literature, is there an indication currently for stress views (with the pt holding weights)?no
List the features of shoulder separation as to what happens to the acromioclavicular ligament (AC), the coracoclavicular ligament (CC), clavicular displacement, and preferred therapy of Type 1 shoulder separation?1) partial sprain 2) intact 3) none 4) conservative
List the features of shoulder separation as to what happens to the acromioclavicular ligament (AC), the coracoclavicular ligament (CC), clavicular displacement, and preferred therapy of Type II shoulder separation?1) complete tear 2) partial sprain 3) slight elevation of distal portion 4) conservative
List the features of shoulder separation as to what happens to the acromioclavicular ligament (AC), the coracoclavicular ligament (CC), clavicular displacement, and preferred therapy of Type III shoulder separation?1) complete tear 2) complete tear 3) superior 4) controversy exists
List the features of shoulder separation as to what happens to the acromioclavicular ligament (AC), the coracoclavicular ligament (CC), clavicular displacement, and preferred therapy of Type IV shoulder separation?1) complete tear 2) complete tear 3) posterior and superior into the trapezius, giving a botton hole appearance 4) surgery
List the features of shoulder separation as to what happens to the acromioclavicular ligament (AC), the coracoclavicular ligament (CC), clavicular displacement, and preferred therapy of Type V shoulder separation?1) complete tear 2)complete tear, more severe than type III, with coracolavicular space increased > 100%, indicating disruption of the deltoid and trapezius fibers 3) 4)
List the features of shoulder separation as to what happens to the acromioclavicular ligament (AC), the coracoclavicular ligament (CC), clavicular displacement, and preferred therapy of Type VI shoulder separation?1) complete tear 2) complete tear 3) inferior 4) surgery
Describe Type I and II injuries?involve partial and complete tears of the AC ligaments, respectively without complete tearing of the CC (coracoclavicular ligaments).
In Type 1 and II injuries, why is there minimal displacement of the clavicle?because coracoclavicular ligament founction is preserved
What is the treatment for Type I and II injuries? pain management and activity resumed as tolerated
Type III, I, V and VI injuries all involve complete tears of which ligaments?AC and CC ligaments
Type IV and VI injuries involve what?posterior, inferior displacement of the clavicle
What is the treatment for IV and VI injuries?surgery
Type III and type V injuries both involve ______ (posterior vs. inferior) displacement of the clavicle?superior
What limits the degree of displacement in type III injuries?the deltoid and trapezius muscles remaining intact
In type III injuries, the CC distance is _____ (increased vs. decreased) by 25-50% compared to the uninjured side?increased
Type V injuries have more extreme displacement due to what?damage tot he deltoid and trapezius fibers
How do you differentiate between type III and V injuries?ask the patient to shrug his shoulders and there is improvement or resolution of displacement with type III but not type V injuries.
Do patients with type V injuries require surgery?yes
What is the treatment for type I and II injuries (know that there may be pain and limited mobility after treatment)?conservative (rest and physical therapy)
Do types IV and VI require surgery?yes
What is the treatment for type III injuries?controversy exists regarding recommendations (conservative, nonoperative management was preferred)
***Recent reviews have failed to demonstrate a clear preference of one approach over the other in type ____ AC dislocation?III
What factors should base individualized treatments for patient's AC injuries?1) patient age 2) level of s/s 3) desire for future activities and performance
Compare the shoulder functional outcome in the surgical group (especially in the younger adult) vs. complication rates?better in the surgical group and complications were greater in the surgical group
What were the rehabilitation time outcome vs the cosmetic results in the nonoperative group?rehab time was shorter but cosmetic results were inferior
Are dislocations of the sternoclavicular joint common?no
Which of the following joints is more resistant to dislocation than the other = AC vs. sternoclavicular joint?sternoclavicular joint
*** SUMMARY = What will the physical findings be on exam in a AC joint dislocation?1) tenderness over the AC joint 2) clavicular displacement palpable
*** SUMMARY = pain is exacerbated by what?cross-body arm adduction
*** SUMMARY = list the radiologic view necessary for evaluation?1) anteroposterior 2) axillary 3) Zanca
memorize
*** SUMMARY = treatment depends on the type of ______? :dislocation / seperationl